NRSE310 EXAM#1 content

pharmacology

study of drugs that alter functions of living organisms

sources of pharmacology

•  natural, animal, mineral, synthetic compounds

pharmacological class

• mechanisms of action, a collection of active compliments with similar features 

ISMP

high alert medications, tall man lettering (bold, capitalized similar lettering)

FDA does not regulate

herbal supplements, dietary supplements

chemical name

• chemical composition and molecular structure 

generic name

 official name of the drug, only 1 (ex. ibuprofen)

Trade name

•  name created by company, need FDA approval (ex. advil)

pharmacokinetics

how medications travel through the body 

• Process by which they are absorbed, distributed, metabolized, and excreted

absorption (what factors go into absorption)

Transmission of the medication from the location of administration to the bloodstream

• Rate of absorption

• Amount of medication absorbed

• Route of administration

• Rate of absorption times: Oral (30mins- hour), Inhalation(5mins), SQ and IM (20 mins), IV (immediate) 

distribution

transportation of medications to sites of action by bodily fluids

• Influencing factors: circulation (low bp, low capillary refill), permeability of cell membrane, plasma protein binding

metabolism (definition, location, tests, rate)

changes from less active or inactive by the action of enzymes

• Primarily occurs in the liver, but also kidneys, lungs, intestines, and blood

• LFTs: liver function test, draw blood to check function 

• Factors affecting rate of metabolism: age, metabolizing enzymes, first pass effect, nutritional status

elimination

•  removal

• Through kidneys most common, liver, lungs, intestines, exocrine glands 

• Kidney function test: BUN, creatinine 

kidney function test

BUN, creatinine

pharmacodynamics

what the drug or medication does to the body, AKA mechanism of action

agonist, antagonist, partial agonist

• Agonist: bind receptors

• Antagonist: stop binding at receptor sites (Narcan) 

• Partial Agonist: still binds to receptors but it has a weaker effect 

Oral Routes

Oral, sublingual, buccal, nasogastric, gastrostomy

Do not crush

capsule, contain enteric coated (there to absorb in different places), delayed release, long acting, extended release, controlled release, modified release, sustained, slow release

routes of admin: topical

Transdermals, eye, ear, nose, rectal (PR), vaginal

routes of admin: Inhalation

MDI (meter dose inhaler), DPI (dry powder inhalation), nebulizer

Routes of med admin: parenteral

• IM: intramuscular 

• SQ: subcutaneous 

• ID: intradermal

• IV: intravenous

• Epidural

Interactions

• drug- drug, drug- food, levels of interaction: A (none), B (minor), C (moderate), D (major), X (do not combine) 

contradictions

 reason NOT to give pt the medication

precautions

vulnerable populations, pediatrics, older adult, pregnancy

Age Related Physiological Changes:

• Pharmacodynamics: less receptors, less sensitive, more sensitive, BEERS criteria 

• Adverse drug reactions

• Pharmacokinetics: absorption (decreased due to higher pH), distribution (slows down), metabolism (slowed), excretion (altered, may be incomplete, kidney function)

polypharmacy

 the use of multiple medications (usually more than 5)

• Increased risk for drug- drug reactions 

• Risk factor for acute confusion, delirium, and depression in older adults 

• Major factor in leading cause of death

• Testing can be done for genetic testing, nursing check lists for medication reactions 

serum drug level

a laboratory measurement of the amount of a drug in the blood at a particular time

• Reflects: Dosage, absorption, Bioavailability, half-life, Rates of metabolism, excretion

toxic concentration

• excessive level of medication in bloodstream; caused by Single large dose, Repeated small doses, or Slow metabolism of medication

therapeutic effect

The desired effect of the drug

adverse effect

any undesired responses to medication administration

• unexpected severe responses to medication (happen at therapeutic or higher than therapeutic doses-Pt has to stop medication) i.e.- itchiness, hives, rash, SOB, tongue/throat edema; anaphylaxis, stridor (anaphylaxis reaction)

side effect

• Problematic, but not harmful responses in tissues where the drug’s effects are neither needed or wanted (happen at therapeutic doses) i.e.- nausea, dry mouth, headache, sleepiness

What to do during ADR (closing airway)

• don’t leave patient if unstable, call rapid, sit high up, apply non rebreather, call provider

medication order must have

 patient name, medication name, dose, route, and time

if time is PRN you need the order to have..

need an indication, like why would I need to give this, and can only give it for indication

Who can give an RN an order

•  physician (MD, DO), clinicians NP, PA, provider, APRN, Midwife

how can medication orders be given

• Typed in computer (preferred)

• Handwritten on an order sheet

• Verbal signs (emergency only usually): signed by the transcriber, countersigned by the prescriber

• Telephone orders: signed by transcriber, countersigned by the prescriber 

Types of medication Orders and timing

• Routine or scheduled orders (1HR before or after it’s due)

• Standing order

• Single or one time ordered: within 1 HR

• STAT orders: within 30mins

• PRN orders

Banned medical abbreviations

• No “U”: write unit 

• No “IU”: write international unit

• NO QD, QOD: write daily or every other day 

• No trailing zero like 4.0 mg: write 4mg

• No MS: write morphine sulfate

rights of medications

Right Patient, medication, dose, route, time, documentation, assessment, education, right to refuse, right evaluation

max administration for deltoid and subcutaneous

1mL

disease

 an interruption, cessation, or dysfunction of a body system or organ structure

etiology

• the cause of disease (risk factors, prevention)

Pain (causes, classifications)

• Causes: surgery, tissue injury, nerve damage neuropathy), cancer 

• Classifications: visceral (organ pain), somatic (more subcutaneous), referred pain (origin from somewhere else)

complications of un relieved pain

• Adaptation: parasympathetic takeover (reaction 

• Endocrine affects: cortisol

• CV/Resp affects: increase

• MSK affects: weakness, fatigue

• GI/GU effects: hypermotility, constipation, urinary retention

Inflammation

• non specific  protective/ coordinated response to infectious agent, injuries agent or disease 

• Acute inflammation: vascular stage, cellular stage, systemic responses

prostaglandins

Chemical mediators found in most body tissues

• Regulating many body functions, inflammatory response

• Are formed when cellular injury occurs

• Exert various and opposing effects on various body tissues

Normal WBC

5,000-10,000 mm3

fever

•  38C/ 100.5 degrees F

inflammatory response

clinical manifestations experienced throughout the body

• Occur as a direct result of the release of inflammatory mediators: Fever, Pain

• Lymphadenopathy (swollen lymph nodes)

• Anorexia (lack of appetite)  

• Drowsiness (sleepy), Lethargy (lack of energy), Anemia (↓ RBC), Weight loss, Tachycardia

Non Opioid Analgesics: medication class:

• Nonsteroidal antinflammatory drugs: cox 1 and cox 2 inhibitors 

PCA

patient controlled analgesia

what do PCA orders need

• Name of opioid

• loading dose (an amount to give when starting the machine)

• dose per each button press, basal rate (how much the patient gets without pressing the button

• lockout (the amount of time in-between doses, and max per hour (mg/hr).

PCA checks and rules

• PCA orders must be checked at shift change

• THE ONLY PERSON WHO CAN PUSH THE PCA BUTTON IS THE PATIENT!

• If the PCA gets discontinued and there is still medicine left, this must be wasted by two RNs and checked off because it is a controlled substance

Non Pharm pain management

• cold packs can be used within 48 hours to injury to reduce inflammation

• hot pack for stiff joint/ muscles not within 48 hours

• Acupuncture, acupressure, massage (therapeutic touch), distraction (humor), relaxation techniques, guided imagery, hypnosis, animal therapy 

Order of action correctly

1. Administer naloxone as prescribed.

2. Stop the fentanyl infusion.

3. Notify the healthcare provider.

4. Assess the patient’s airway and oxygenation.

5. Reassess respiratory status

 2,4,3,1,5

medical adherence and factors

refers to how well a client follows their medication treatment plan.

• Barriers, Illness that prohibits, Logistical concerns, Financial barriers, Social and cultural barriers, Language barriers

LARA (what it does and stand for)

 help a nurse respond to their clients in a culturally competent manner

• Listen to the client’s needs related to cultural values and emotions.

• Affirm what the client says by paraphrasing their comments.

• Respond by clarifying any uncertainties.

• Add information or comments to promote greater client understanding.

perceptual vs practical

• Perceptual: religion, race, culture

• Practical: cost, distance to pharmacy, child care